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Malignant Hypertension

Definition

Malignant hypertension is blood pressure that is so high that it is actually causing damage to organs, particularly in the nervous system, the cardiovascular system, and/or the kidneys. One type of such damage is called papilledema, a condition in which the optic nerve leading to the eye becomes dangerously swollen, threatening vision.

This is a serious condition that requires immediate care. Rapid treatment can prevent long-term problems. Left untreated, damage from malignant hypertension occurs quickly and can be severe, involving organ damage to blood vessels, the eyes, heart, spleen, kidneys, and brain. In particular,
kidney failure
may develop since the blood vessels inside the kidneys are very sensitive to high blood pressure.

Missing doses of prescribed antihypertensive medications, particularly beta-blockers or clonidine, which can cause a rebound effect. Medication noncompliance is the most common reason for hypertensive emergencies.

Risk Factors

Malignant hypertensive is more common in men, African Americans, and in smokers. You are more likely to develop malignant hypertension if you have already have essential hypertension—high blood pressure of 140/90 or higher.

Symptoms

Malignant hypertension produces noticeable symptoms, including:

Chest pain

Difficulty breathing

Headache

Visual problems

Nausea and vomiting

Numbness/weakness of the legs, arms, face

In particular, malignant hypertension can lead to a condition called hypertensive encephalopathy. Symptoms of this condition include
headache, vomiting, blurry vision with papilledema, mental changes like
anxiety
, confusion, fatigue, and seizure.

If you experience any of the above symptoms, do not assume it is due to malignant hypertension. These symptoms may be caused by other health conditions, including a
heart attack
or other less serious disorders. If you experience any one of them, call for emergency medical services right away.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your blood pressure readings will probably be very high. Readings will be taken in both arms, while lying down and while standing up. A careful stethoscope exam of your heart and a detailed neurological exam will be performed. An eye exam may show signs of high blood pressure, including swelling of the optic nerve or bleeding inside the eye.

Renal duplex or
ultrasound
test of the kidney's arteries to look for blockage

Treatment

Since malignant hypertension is a medical emergency, treatment needs to be received quickly. Treatment options include the following:

IV high blood pressure medications–The specific medication will be chosen based on your specific situation, including whether you are suffering from damage to your kidneys or other organs. Possible medications may include:

Sodium nitroprusside or nitroglycerin

Beta-blockers

Hydralazine

Labetalol

Vasotec and ACE-inhibitor

Oral high blood pressure medicines once blood pressure has been lowered from dangerous levels

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.